Treatment device for cutting living tissue

ABSTRACT

According to one aspect of the present invention, there is provided a treatment device for cutting a living tissue, comprising a main unit which is to be inserted into a body, a tip-end treatment portion which is disposed at a tip end of the main unit to cut the living tissue, a notch groove which is disposed at the tip-end treatment portion and which compresses the living tissue guided into the notch groove, and an electrode which is positioned in a part of the notch groove and which electrically cuts the living tissue compressed by the notch groove.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is based upon and claims the benefit of priorityfrom the prior Japanese Patent Applications No. 2001-401941, filed Dec.28, 2001, and No. 2001-401942, filed Dec. 28, 2001, the entire contentsof both of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The present invention relates to a living tissue cuttingtreatment device for cutting living tissues such as a blood vessel.

[0004] 2. Description of the Related Art

[0005] Various electric treatment devices of monopolar type and bipolartype are known, which are configured to cut living tissues such as ablood vessel. U.S. Pat. No. 5,445,638, for example, discloses atreatment device comprising a pair of jaws that have an electrode each.The jaws can be opened and closed. When closed, the jaws clamp a bloodvessel. While the blood vessel is so clamped, a current is made to flowin the electrodes, coagulating the clamped part of the blood vessel iscoagulated. The blood vessel is thereby cut. Another type of a treatmentdevice is known, which has a blade that is moved to cut a blood vessel.

[0006] With these conventional treatment devices cannot cut a bloodvessel when the treatment portion (electrode portion) is simply pressedonto the object blood vessel. They cannot cut blood vessels unless thejaws are opened and closed or the blade pressed on the blood vessel ismoved back and forth.

BRIEF SUMMARY OF THE INVENTION

[0007] An object of the present invention is to provide a treatmentdevice for coagulating and cutting a living tissue, which can easily cutliving tissues such as a blood vessel.

[0008] The object of the present invention is achieved by the followingtreatment device for cutting a living tissue. That is, according to oneaspect of the present invention, there is provided a treatment devicefor cutting a living tissue, comprising: a main unit which is to beinserted in a body; a tip-end treatment portion which is disposed at atip end of the main unit to cut the living tissue; a notch groove whichis disposed at the tip-end treatment portion and into which the livingtissue is introduced to thereby compress this living tissue; and anelectrode which is positioned in a part of the notch groove and whichcoagulates and electrically cuts the living tissue compressed by thenotch groove.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

[0009]FIG. 1 is an exploded side view of a living tissue harvestingapparatus according to a first embodiment of the present invention;

[0010]FIG. 2A is a perspective view of a trocar;

[0011]FIG. 2B is a longitudinal sectional side view of the trocar;

[0012]FIG. 3A is a longitudinal sectional side view of a treatmentsheath from which a rigid endoscope is removed;

[0013]FIG. 3B is a plan view of a tip end of the treatment sheath ofFIG. 3A;

[0014]FIG. 4 is a longitudinal sectional plan view of the treatmentsheath from which the rigid endoscope is removed;

[0015]FIG. 5 is a longitudinal sectional side view of the treatmentsheath through which the rigid endoscope is inserted;

[0016]FIG. 6 is a longitudinal sectional plan view of the treatmentsheath through which the rigid endoscope is inserted;

[0017]FIG. 7 is a diagram seen from an arrow 7 direction of FIG. 5;

[0018]FIG. 8 is a longitudinal sectional side view of the tip end of adissector;

[0019]FIG. 9A is a perspective view of a blood vessel harvestingapparatus;

[0020]FIG. 9B is a perspective view of a tip end of the blood vesselharvesting apparatus;

[0021]FIG. 9C is a front view of the tip end of the blood vesselharvesting apparatus;

[0022]FIG. 10A is a top plan view of a bipolar cutter;

[0023]FIG. 10B is a longitudinal sectional side view of the bipolarcutter;

[0024]FIG. 10C is a lower surface view of the bipolar cutter;

[0025]FIG. 11A is a top plan view of a blood vessel holder;

[0026]FIG. 11B is a longitudinal sectional side view of the blood vesselholder;

[0027]FIG. 11C is a front view of the blood vessel holder;

[0028]FIG. 12A is a top plan view of a wiper;

[0029]FIG. 12B is a sectional view taken along a line 12B-12B of FIG.12A;

[0030]FIG. 13 is a perspective view of a wiper operation portion;

[0031]FIG. 14 is a diagram of a state in which a cut skin portion isformed in a leg;

[0032]FIG. 15 is a sectional view of a state in which the trocar isattached to the cut skin portion of the leg and the trocar is used as aguide to insert the dissector into a cavity;

[0033]FIG. 16 is a whole constitution diagram of a state in which thetrocar is used as the guide to insert the treatment sheath into thecavity;

[0034]FIG. 17 is a diagram showing a monitor image;

[0035]FIG. 18 is a sectional view of the state in which the treatmentsheath is inserted in the cavity;

[0036]FIG. 19 is a sectional view of a treatment state in the cavity;

[0037]FIG. 20 is a diagram showing the monitor image;

[0038]FIGS. 21A to 21C are perspective views showing a function of theblood vessel holder;

[0039]FIG. 22 is a sectional view inside the body in the treatmentstate;

[0040]FIG. 23 is a diagram showing the monitor image;

[0041]FIG. 24 is a diagram showing the monitor image;

[0042]FIGS. 25A to 25C are plan views showing the function of thebipolar cutter;

[0043]FIGS. 26A and 26B are sectional views inside the body showing thefunction of the bipolar cutter;

[0044]FIG. 27 is a sectional view inside the body in the treatmentstate;

[0045]FIG. 28 is a diagram showing the monitor image;

[0046]FIG. 29 is a perspective view of the tip end of the treatmentsheath;

[0047]FIG. 30 is a perspective view of the tip end of the treatmentsheath;

[0048]FIG. 31 is a perspective view of the tip end of the treatmentsheath;

[0049]FIG. 32A is a plan view of a tip-end treatment portion of thebipolar cutter according to a first modification example;

[0050]FIG. 32B is a longitudinal sectional side view of the tip-endtreatment portion of FIG. 32A;

[0051]FIG. 33 is a diagram showing a use mode of the bipolar cutter ofFIG. 32A;

[0052]FIG. 34 is a sectional view along a line 34-34 of FIG. 33;

[0053]FIG. 35 is a sectional view showing the use mode of the bipolarcutter of FIG. 32A;

[0054]FIG. 36 is a sectional view showing the use mode of the bipolarcutter of FIG. 32A;

[0055]FIG. 37 is a sectional view showing the use mode of the bipolarcutter of FIG. 32A;

[0056]FIG. 38 is a perspective view showing another use mode of thebipolar cutter of FIG. 32A;

[0057]FIG. 39 is a plan view showing a first stage of the use mode ofthe bipolar cutter of FIG. 32A;

[0058]FIG. 40 is a plan view showing a second stage of another use modeof the bipolar cutter of FIG. 32A;

[0059]FIG. 41 is a plan view showing a third stage of the other use modeof the bipolar cutter of FIG. 32A;

[0060]FIG. 42 is a perspective view showing a fourth stage of the otheruse mode of the bipolar cutter of FIG. 32A;

[0061]FIG. 43 is a perspective view of the tip end of the blood vesselharvesting apparatus in which the bipolar cutter according to a secondmodification example is incorporated;

[0062]FIG. 44 is a perspective view of the treatment device for cuttingthe living tissue (bipolar cutter) according to a second embodiment ofthe present invention;

[0063]FIG. 45 is a side sectional view of the bipolar cutter of FIG. 44;

[0064]FIG. 46 is a diagram showing a state in which a leg is incisedalong the blood vessel FIG. 47 is a diagram showing the use mode of thebipolar cutter of FIG. 44;

[0065]FIG. 48 is a diagram showing another use mode of the bipolarcutter of FIG. 44;

[0066]FIG. 49A is a plan view of the tip-end treatment portion showingthe modification example of a formed mode of an electrode in the bipolarcutter;

[0067]FIG. 49B is a sectional view along a line 49B-49B of FIG. 49A;

[0068]FIG. 50A is a plan view of the tip-end treatment portion showinganother modification example of the formed mode of the electrode in thebipolar cutter;

[0069]FIG. 50B is a sectional view along a line 50B-50B of FIG. 50A;

[0070]FIG. 51 is a perspective view showing the modification example ofthe bipolar cutter shown in FIG. 44;

[0071]FIG. 52A is a plan view of the tip-end treatment portion of thebipolar cutter of FIG. 51;

[0072]FIG. 52B is a side sectional view of the bipolar cutter of FIG.51;

[0073]FIG. 53 is a schematic constitution diagram of the treatmentdevice for cutting the living tissue (monopolar cutter) according to athird embodiment of the present invention;

[0074]FIG. 54A is a plan view of the tip-end treatment portion of thetreatment device for cutting the living tissue of FIG. 53; and

[0075]FIG. 54B is a sectional view along line 54B-54B of FIG. 54A.

DETAILED DESCRIPTION OF THE INVENTION

[0076] Embodiments of the present invention will be describedhereinafter with reference to the drawings.

[0077]FIG. 1 shows an endoscopic blood vessel harvesting apparatus as aliving tissue harvesting apparatus in which a treatment device forcutting a living tissue according to a first embodiment of the presentinvention is incorporated. This apparatus is constituted of: a trocar 1;a treatment sheath 2; a dissector 3 as expansion means; and a rigidendoscope 4 as an endoscope.

[0078] As shown in FIGS. 2A and 2B, the trocar 1 is integrally molded ofa synthetic resin material, and a cylindrical guide tube 6 is obliquelyinserted through a substantially disc-shaped flange 5. The inner andouter surfaces of the guide tube 6 are coated with a lubricant in orderto improve slip at an insertion time. A tip end 6 a of the guide tube 6is cut at an acute angle, and the end surface of the tip end 6 a isformed substantially in parallel to the flange 5.

[0079] Furthermore, an airtight ring portion 7 is integrally disposed inan inner peripheral surface in a base end of the guide tube 6, and anair supply head 8 is integrally disposed in a middle portion. Moreover,an adhesive layer 9 such as an adhesive tape is disposed on the lowersurface of the flange 5, and the trocar 1 can be fixed so as to adhereto a scurf skin.

[0080] The treatment sheath 2 will next be described. The sheath isconstituted as shown in FIGS. 3A, 3B and 4. A sheath main unit 10 is astraight cylindrical member formed of a synthetic resin material, andthe surface of the unit is coated with a lubricant to improve slip at aninsertion time. An operation portion cover 11 constituting a graspportion is attached to a proximal end of the sheath main unit 10, and atip end cover 12 is attached to a distal end.

[0081] As shown in FIGS. 3A and 3B, an endoscope channel 13 is disposedover the whole length of an axial center portion of the sheath main unit10. The proximal end of the endoscope channel 13 projects on a hand sidethrough the operation portion cover 11, and a flange portion 13 aprojecting from the front end surface of the sheath main unit 10 isdisposed in a distal end. A first treatment device channel 14 isdisposed in a portion eccentric upwards and a second treatment devicechannel 15 is disposed in a portion eccentric downwards so that theendoscope channel 13 is held between the channels in the sheath mainunit 10. Therefore, the first treatment device channel 14 and secondtreatment device channel 15 are substantially symmetrically arranged inpositions most apart from each other via the endoscope channel 13.

[0082] The proximal end of the first treatment device channel 14 opensin a first slide operation portion 16 inside the operation portion cover11, and the proximal end of the second treatment device channel 15 opensin a second slide operation portion 17 in the operation portion cover11. A bipolar cutter 18 as a treatment device for cutting a livingtissue described later is inserted through the first treatment devicechannel 14 so that the cutter can move forwards/backwards in an axialdirection, and a treatment device operation portion 19 is disposed in arange of an elongate hole 16 a of the first slide operation portion 16in the proximal end so that the portion can slide in the axialdirection. When the treatment device operation portion 19 is pulled tothe proximal end, the distal end of the bipolar cutter 18 can be held inthe first treatment device channel 14. Moreover, the bipolar cutter 18is connected to a bipolar cable 20, and the bipolar cable 20 is derivedtoward the outside through the elongate hole 16 a.

[0083] A blood vessel holder 21 as a blood vessel holding memberdescribed later is inserted through the second treatment device channel15 in such a manner that the holder can move forwards/backwards in theaxial direction, and a holder operation portion 22 is disposed in arange of an elongate hole 17 a of the second slide operation portion 17in the proximal end in such a manner that the portion can slide in theaxial direction.

[0084] Furthermore, as shown in FIG. 4, a through hole 23 is disposed inthe axial direction in one side portion of the endoscope channel 13inside the sheath main unit 10. A wiper rod 25 of a wiper 24 describedlater is inserted through the through hole 23 in such a manner that therod can rotate. The distal end of the wiper rod 25 is bent substantiallyin an L shape, and a wiper rubber 26 is disposed on the tip end of therod.

[0085] The proximal end of the wiper rod 25 extends to a rotatingoperation portion 27 inside the operation portion cover 11, and isrotatably supported on the inner wall of the operation portion cover 11.A wiper operation portion 28 is fixed to the proximal end of the wiperrod 25, and the wiper operation portion 28 can rotate in a range of anelongate hole 27 a which extends in a peripheral direction of theoperation portion cover 11.

[0086] Moreover, an endoscope holding portion 30 is disposed on the handside of the operation portion cover 11 in a fixed state with respect tothe endoscope channel 13. The endoscope holding portion 30 includes asufficient cavity for containing an eyepiece portion 31 of the rigidendoscope 4, and a cutout portion 34 into which a light guide head 33disposed on the eyepiece portion 31 is inserted/engaged is formed in apart (upper part) of a peripheral wall 32.

[0087] Therefore, as shown in FIGS. 5 to 7, an insertion portion 35 ofthe rigid endoscope 4 is inserted into the endoscope channel 13, thelight guide head 33 is inserted/engaged into the cutout portion 34 so asto hold the eyepiece portion 31 in the endoscope holding portion 30, therigid endoscope 4 is then held with respect to the treatment sheath 2and positioned in the axial direction. The sheath main unit 10 and theoperation portion cover 11 are secured to the endoscope channel 13 andcan rotate. The endoscope channel 13 and endoscope holding portion 30are fixed. Hence, that part of the treatment sheath 2 which is moredistal from the cover 11 than the rigid endoscope 4 can be held androtate in rotatable state, as long as the treatment sheath 2 and therigid endoscope 4 remain coupled together.

[0088] The bipolar cutter 18 will next be described.

[0089] As shown in FIGS. 9A to 10C, the bipolar cutter 18 includes: acutter main unit 40 which is inserted in a body; a tip-end treatmentportion 40 a which is disposed in the tip end of the cutter main unit 40to cut the blood vessel; and electrodes 42, 43 which are disposed in thetip-end treatment portion 40 a to electrically cut the blood vessel. Thecutter main unit 40 is formed of an insulating member (including aceramic member) such as a synthetic resin material, and has a shape of astrip plate member bent in a arc shape along a arc inner peripheralsurface of the sheath main unit 10. The curved shape (roof shape) of thecutter main unit 40 prevents the tissue from sagging from the upper side(presses/discharges a fat tissue in a body cavity) as described later,and is useful for securing the view field of the rigid endoscope 4.

[0090] A guide portion for guiding the blood vessel into the electrodes42 and 43 with the movement of the cutter main unit 40 in the axialdirection is formed in the tip-end treatment portion 40 a of the cuttermain unit 40. In the present embodiment, the guide portion is formed bya notch groove (slit) 41 cut in a V shape. In this case, sides 41 a, 41b forming the V shape extend upwards to the top portion of the arcportion on the proximal-end side from opposite edges of the distal endof the cutter main unit 40, and form a tissue guide surface of the notchgroove (hereinafter referred to as the V groove) 41 which tapers on theproximal-end side.

[0091] A pair of electrodes 42, 43 disposed opposite to each other arefixed/disposed on a bottom of the V groove 41, that is, an intersectionof the respective sides 41 a, 41 b forming the V shape. The electrodes42, 43 are not disposed in the same plane, and are positioned verticallyopposite to each other.

[0092] Of these two electrodes, the upper electrode 42 has a surfacearea larger than that of the lower electrode 43. That is, the upperelectrode 42 contacts tissues at a large area, whereas the lowerelectrode 43 contacts tissues at a small area. Hence, the lowerelectrode 42 is used mainly as a cutting electrode, and the upperelectrode 43 is used mainly as a coagulation electrode.

[0093] In general, the electrode having a large contact area is higherthan the electrode having a small contact area in a bleeding stopcapability at an incision time. As described later (see FIGS. 26A to27), an incised portion of the incised side branch 72 of the extractedblood vessel 61 is bound with a ligature after extracting the bloodvessel 61. However, the incised portion on a patient side remains in thebody as such, it is preferable to stop the bleeding. Therefore, in thepresent embodiment, the electrode 43 functioning as the incisionelectrode and having the small contact area is disposed on a lower side,that is, on a side of the blood vessel 61 to be extracted (the side ofthe blood vessel holder 21 for holding the blood vessel 61 as describedlater). The electrode 42 which functions as the coagulation electrodeand has the large contact area is disposed on an upper side, that is, onthe body side (the side remaining in the body). Moreover, a reason whythe electrode 42 having the large contact area is disposed on the upperside, that is, the body side is that the body-side electrode 42 isdisposed as far from the blood vessel 61 to be harvested as possible andthermal influence onto the blood vessel 61 is minimized. Hereinafter,the upper electrode 42 will be referred to as “body-side electrode,” andthe lower electrode 43 will be referred to as “cut electrode.”

[0094] The body-side electrode 42 and cut electrode 43 are connected tolead wires 44, 45, and these lead wires 44, 45 are laid along the upperand lower surfaces of the cutter main unit 40, and connected to thebipolar cable 20. Furthermore, the lead wires 44, 45 are coated withinsulating films 46, 47, and insulated. It is to be noted that portionsof the bipolar cutter 18 other than the electrodes 42, 43 may also beformed by a transparent material (acryl, and the like).

[0095] The blood vessel holder 21 according to the present embodimentwill next be described in detail with reference to FIGS. 11A to 11C. Asshown in FIGS. 11A to 11C, the blood vessel holder 21 includes oneoperation rod 50 as a shaft portion which is moved forwards/backwards inthe sheath main unit 10, and a main unit which is disposed in the tipend of the operation rod 50 to hold the harvesting object blood vessel61. The main unit is formed of the synthetic resin materialsubstantially in a triangular shape in a plan view, the upper surface isformed in a flat surface 48, and the lower surface is formed in a arcconcave surface 49 which forms a press groove to press the harvestedblood vessel 61. This arc concave surface 49 functions as a pressdischarge portion which presses/discharges the harvested blood vessel 61in a direction apart from the bipolar cutter 18 as described later.Moreover, the operation rod 50 is connected to a lopsided position in arear-end portion of the blood vessel holder 21 (the operation rod 50 isconnected to a position eccentric from a center axis of the main unit ofthe blood vessel holder 21). It is to be noted that the operation rod 50is inserted through the second treatment device channel 15 so as to bemovable forwards/backwards.

[0096] The tip end of the blood vessel holder 21 is formed as anacute-angled stripping portion 51 for stripping the tissue. Moreover,first left and right taper surfaces 52 a, 52 b are symmetrically formedin the blood vessel holder 21 so as to be linked from the strippingportion 51. That is, the tip end of the main unit is formed in a tapershape which tapers at the acute angle. Furthermore, inclined surfaces 53a, 53 b are formed in upper and lower surfaces of the stripping portion51 toward the tip end so that the upper and lower surfaces have a smallwidth. A hem portion of the first taper surface 52 a on a side oppositeto the connected portion of the blood vessel holder 21 to the operationrod 50 is formed on a second taper surface 54 which has a arc shape, andthe second taper surface 54 is continued to a hook portion 55 includinga flat surface which is positioned in the rear end of the blood vesselholder 21 so as to catch the blood vessel. That is, the main unitfurther includes the rear end for catching the living tissue.Concretely, as shown in FIG. 3B, the hook portion 55 is disposed in aposition opposite to the bipolar cutter 18 in the axial direction.

[0097] Opposite side walls of the blood vessel holder 21 forming the arcconcave surface 49 include a third taper surface 59 which extendsdownwards from the stripping portion 51, and a fourth taper surface 58which extends downwards from the hook portion 55.

[0098] The wiper 24 will be described in detail. The wiper isconstituted as shown in FIGS. 12A and 12B. That is, the wiper rubber 26fixed to the distal end of the wiper rod 25 is fixed to an L-shapedfolded portion of the wiper rod 25 by adhesion or insert molding, and isdisposed at right angles to the axial direction. The wiper rubber 26includes a scraping portion 26 a which has a triangular section andflexibility. Thereby, by rotation of the wiper rubber 26, foreignparticles sticking to the objective lens surface 4 a of the rigidendoscope 4, such as blood, mucosa, and fat, can be scraped off. In thiscase, the scraping portion 26 a has flexibility. Therefore, even when astepped portion is generated between the tip end surface of the sheathmain unit 10 and the objective lens surface 4 a, the rubber goes beyondthe stepped portion and slides against the objective lens surface 4 a.

[0099] As shown in FIG. 13, one end of the torsion coil spring 29including the coil spring disposed on the wiper rod 25 of the wiper 24abuts on the end surface of the sheath main unit 10, and the other endis disposed between the unit and the wiper operation portion 28 in acompressed state and is further engaged with the side surface of thewiper operation portion 28. Therefore, the torsion coil spring 29generates a rotation torque T for rotating the wiper rod 25 in onedirection, and a force F for urging the wiper rod 25 toward the proximalend direction of the sheath main unit 10. Thereby, the wiper rubber 26is urged in a direction in which the rubber retreats to the side of theobjective lens surface 4 a of the rigid endoscope 4, and a direction inwhich the rubber contacts the objective lens surface 4 a.

[0100]FIGS. 9A and 9B show that the insertion portion 35 of the rigidendoscope 4 is inserted into the endoscope channel 13 of the treatmentsheath 2. In this state, the bipolar cutter 18 and blood vessel holder21 projects from the tip end of the treatment sheath 2. The bipolarcable 20 is connected to a high-frequency generation apparatus 56, and alight guide cable 57 is connected to the light guide head 33.

[0101] The dissector 3 will next be described. As shown in FIG. 8, aninsertion path 37 for passing through the insertion portion 35 of therigid endoscope 4 is disposed in the axial center portion of aninsertion cylindrical portion 36 which has a straight cylindrical shape.Hydrophilic coating is provided on the surface of the insertioncylindrical portion 36 in order to improve the slip at the insertiontime. A stripping member 38 formed in a conical shape by a transparentsynthetic resin material is fixed to the distal end of the insertioncylindrical portion 36. An endoscope holding portion 39 is disposed inthe proximal end of the insertion cylindrical portion 36 so that theeyepiece portion 31 of the rigid endoscope 4 is held. It is to be notedthat the endoscope holding portion 39 preferably includes the sameconstitution as that of the endoscope holding portion 30 of thetreatment sheath 2.

[0102] A case will be described in which the blood vessel harvestingapparatus constituted as described above is used to harvest a bloodvessel as a harvesting object (hereinafter referred to as the bloodvessel) such as a great saphenous vein extending over the whole lengthincluding a inguinal portion A of a thigh of a leg and an ankle. Theblood vessel thus harvested can be used as a graft blood vessel in, forexample, bypass transplantation for the coronary artery.

[0103]FIG. 14 shows a leg 60 and blood vessel 61. First, when the bloodvessel 61 between a knee 62 and inguinal portion 63 is harvested, a cutskin portion 64 is made in one portion of the knee 62 right above theblood vessel 61 by a scalpel.

[0104] Subsequently, the blood vessel 61 is exposed in the cut skinportion 64 by a forceps. Furthermore, a tissue right above the bloodvessel 61 is stripped by a distance which can be observed through thecut skin portion 64 with the naked eyes with a similar forceps.

[0105] Subsequently, the rigid endoscope 4 is inserted into thedissector 3. The endoscope 4 is thereby held in the endoscope holdingportion 39 and secured to the light guide head 33. The stripping member38 is passed is photographed by a TV camera 75 coupled to a TV camerahead 74 that is connected to the eyepiece portion 31 of the rigidendoscope 4 inserted in the insertion cylindrical portion 36. A monitor76 displays the image of the member 38 thus photographed. As shown inFIG. 15, the stripping member 38 is inserted along the blood vessel 61.Where the member is little inserted, the guide tube 6 of the trocar 1 isobliquely inserted toward the inguinal portion 63 (substantially inparallel to the blood vessel 61, the tip end 6 a is turned downwards,and the adhesive layer 9 in the lower surface of the flange 5 isbonded/fixed to a scurf skin 65. In this state, an air supply tube 67connected to an air supply pump 66 is connected to the air supply head8.

[0106] In this case, since the outer peripheral surface of the insertioncylindrical portion 36 is closely attached to the airtight ring portion7, the inside of the guide tube 6 and cavity 69 is brought into anairtight state, and an air supply path 68 is secured between the guidetube 6 and insertion cylindrical portion 36.

[0107] The light guide head 33 of the rigid endoscope 4 is connected toa light source apparatus 78 via the light guide cable 57. Therefore, thecavity 69 can be irradiated and illuminated with an illuminating lightfrom the tip end of the rigid endoscope 4. When the air supply pump 66is driven, air is supplied into the cavity 69 via the air supply tube67, air supply head 8, and air supply path 68, and the cavity 69 isexpanded. At this time, since the insertion cylindrical portion 36 ofthe dissector 3 adheres to the airtight ring 7, gas does not leak to theoutside, and the cavity 69 can therefore securely be expanded.

[0108] A subcutaneous tissue 70 as a lower layer of the scurf skin 65and connective tissue on the blood vessel 71 exist in the cavity 69.Moreover, the blood vessel 61 exists in the lower part of the connectivetissue on the blood vessel 71, a plurality of side branches 72 arebranched from the blood vessel 61, and the other ends of the sidebranches 72 are connected to the connective tissue on the blood vessel71. Moreover, a subcutaneous fat 73 is attached to the connective tissueon the blood vessel 71. At this time, when the monitor image is checked,the image is displayed as shown in FIG. 17. The operator can clearlyobserve the blood vessel 61 and side branches 72 by the monitor 76. Itis to be noted that a reference numeral 38 a in FIG. 17 denotes theimage of the tip end of the stripping member 38 of the dissector 3.

[0109] In this way, during the inserting of the dissector 3, in a statein which the cavity 69 is observed by the monitor 76, the connectivetissue on the blood vessel 71, blood vessel 61, and side branches 72 arestripped by the stripping member 38 without damaging the side branches72, and the stripping member 38 is gradually moved forwards by anoperation comprising: little pushing inwards; or little returning themember 38. At this time, even when the dissector 3 isvertically/transversely swung, the trocar 1 is not detached from thescurf skin 65. This is because the trocar 1 is fixed to the scurf skin65 by the adhesive layer 9. In this manner, the dissector 3 is movedfrom the knee 62 toward the inguinal portion 63 along the blood vessel61.

[0110] The operation described above is repeated several times on thetissue surrounding the blood vessel so that the blood vessel may bepeeled off at the harvesting region.

[0111] When a manual stripping operation is completed by using thedissector 3, the dissector 3 is extracted from the trocar 1. The rigidendoscope 4 is detached from the dissector 3. As shown in FIG. 16, theendoscope 4 is inserted into the treatment sheath 2. The sheath 2holding the rigid endoscope 4 is inserted into the guide tube 6 of thetrocar 1. The operation then goes to a treatment step.

[0112] In the treatment step, air is applied from the air supply pump66. The dissector 3 holds the tissue scraped. The treatment is performedin the view field of the endoscope, by using treatment sheath 2inserted.

[0113] While the operation portion cover 11 of the treatment sheath 2 isgrasped with operator's one hand, for example, the holder operationportion 22 is moved forwards with the operator's thumb, and the bloodvessel holder 21 then projects from the tip end cover 12 of the sheathmain unit 10. Moreover, the cutter operation portion 19 is movedforwards with the index finger of the hand in which the operationportion cover 11 is held, and the bipolar cutter 18 then projects fromthe tip end cover 12. That is, while the operator holds the operationportion cover 11 with one hand, the operator can move the blood vesselholder 21 or bipolar cutter 18 forwards/backwards.

[0114] Therefore, as shown in FIG. 18, when a large amount ofsubcutaneous fat 73 exists in the connective tissue on the blood vessel71 of the cavity 69, the treatment sheath 2 is pushed forwards to expandthe cavity 69 in a projected state of the bipolar cutter 18. At thistime, the bipolar cutter 18 prevents the tissue from sagging downwards(presses/discharges the fat tissue in the body cavity) by the curvedshape (roof shape) of the cutter main unit 40, so that the view field ofthe rigid endoscope 4 can satisfactorily be secured. Also, at this time,since the lower surface of the blood vessel holder 21 is formed in thearc concave 49, the holder can be slid and moved forwards on the uppersurface of the blood vessel 61, and the blood vessel 61 is not stoppedfrom being damaged.

[0115] As shown in FIG. 19, the side branches 72 are buried in thesubcutaneous fat 73 in some case. In this case, the blood vessel holder21 is projected from the treatment sheath 2, and the stripping portion51 of the blood vessel holder 21 is pressed onto the subcutaneous fat 73to strip the subcutaneous fat 73 from the blood vessel 61 or the sidebranch 71. When the whole treatment sheath 2 is rotated in theperipheral direction in the guide tube 6 of the trocar 1, the bloodvessel holder 21 can be rotated to exfoliate the subcutaneous fat 73from the side branch 72. Since this state is displayed as the monitorimage in the monitor 76 as shown in FIG. 20, the operator can confirmthe posture of the blood vessel holder 21 by the monitor image, and theblood vessel 61 and side branch 72 are prevented from being damaged.

[0116] While the subcutaneous fat 73 of the cavity 69 is removed, thetreatment sheath 2 is pushed into the cavity 69, and the blood vesselholder 21 is allowed to approach the side branch 72 as a target. Also inthis case, the arc concave 49 is brought in contact with the uppersurface of the blood vessel 61, the holder is slid on the upper surfaceof the blood vessel 61 and can be moved forwards, and the blood vessel61 is prevented from being damaged.

[0117]FIGS. 21A to 21C show a manual operation of holding the sidebranch 72 by the blood vessel holder 21. The blood vessel holder 21 hasthe first taper surface 52 a, and this surface is continued to thesecond taper surface 54, the blood vessel holder 21 is moved forwards,and the side branch 72 first is brought in contact with the first tapersurface 52 a (see FIG. 21B).

[0118] When the blood vessel holder 21 is further moved forwards, theside branch 72 contacts the second taper surface 52 b from the firsttaper surface 52 a falls, sliding on the hook portion 55, and caught bythe hook portion 55 (see FIG. 21C). That is, the first taper surface 52a (or the second taper surface 52 b) can allow the blood vessel holder21 to contact the side branch 72, escape from the side branch 72, andeasily move ahead of the side branch 72 (side opposite to the view fieldwith respect to the side branch 72). Moreover, the third taper surface59 also largely contributes to the ease of forward movement of the bloodvessel holder 21. That is, because of the presence of the third tapersurface 59, the blood vessel holder 21 can smoothly move forwardswithout being caught by the tissue which exists below. Therefore, theside branch 72 can easily be held by the forward operation of the bloodvessel holder 21.

[0119] When the middle of the side branch 72 is hooked on the hookportion 55 of the blood vessel holder 21 and the blood vessel holder 21is drawn on the hand side (at this time, for example, the hook portion55 is relatively moved with respect to the bipolar cutter 18), tensionis applied to the side branch 72 as shown in FIG. 22. At this time, theblood vessel holder 21 can smoothly move toward the hand side withoutbeing caught by the tissue disposed below because of the presence of thefourth taper surface 58. Since one operation rod 50 is connected to theblood vessel holder 21 at this time, and the observation view field issatisfactory. The operation rod 50 is connected to the positioneccentric from the center axis of the blood vessel holder 21, and theoperation rod 50 lies right above the blood vessel 61. This broadens theobservation view further. Therefore, the running of the blood vessel Ccan easily and clearly be conformed. Hence, the blood vessel holder 21can hold the side branch 72 more readily and firmly. As a result, it iseasy to apply the tension to the side branch 72. Particularly, if theblood vessel holder 21 is formed of the transparent material, thevisibility of the blood vessel and tissue can further be improved(therefore, in another preferred embodiment of the present invention,the blood vessel holder 21 is formed by the transparent material).

[0120]FIG. 23 shows the monitor image in which the side branch 72 ishooked on the hook portion 55 of the blood vessel holder 21. An operatorcan check by this monitor image that the side branch 72 has been held.When the side branch 72 is held by the blood vessel holder 21 not on thehand side, but on the opposite side of the side branch 72, the sidebranch 72 is positioned on the hand side of the observation view field,and the periphery of the side branch 72 can clearly be confirmed by therigid endoscope 4 (when the blood vessel holder 21 is disposed on thehand side of the side branch 72, the blood vessel holder 21 obstructsthe front observation view field, and the positional states of the sidebranch 72 and blood vessel 61 cannot satisfactorily be confirmed).Therefore, as described later, the side branch 72 can safely be cutwithout damaging the blood vessel 61.

[0121] When the state shown in FIG. 23 is formed, next the bipolarcutter 18 is moved forwards (the bipolar cutter 18 is relatively movedwith respect to the hook portion 55) and approaching the side branch 72held by the blood vessel holder 21. The hook portion 55 of the holder 21may not be used, depending upon the position that the side branchassumes. Rather, the side branch may be held at a position away from thehook portion 55. In this case, the blood vessel 61 can be held in thearc concave 49. Further, as seen from the monitor image of FIG. 24, theblood vessel 61 can be moved backwards from the bipolar cutter 18 byusing the blood vessel holder 21, preventing the bipolar cutter 18 fromcontacting the blood vessel 61. This operation can easily be achieved bydisposing the bipolar cutter 18 opposite to the blood vessel holder 21as described above. By this arrangement, a predetermined distance cansecurely be kept between the incised/treated portion of the side branch72 and the blood vessel 61, the side branch 72 is incised by the bipolarcutter 18 in the position apart from the blood vessel 61, and the bloodvessel 61 can be prevented from being damaged. When the predetermineddistance can be kept between the incised/treated portion of the sidebranch 72 and the blood vessel 61 in this manner, a knot margin can besecured in binding the cut portion of the side branch 72 left on theblood vessel 61 side with a ligature or the like, after the side branch72 is cut and the blood vessel 61 is extracted. This constitution istherefore useful.

[0122] As seen from the monitored image shown in FIG. 24, the hookportion 55 of the blood vessel holder 21 may not used, depending uponthe positions that the blood vessel 61 and the side branch 72 take.Instead, the other part of the holder 21, located outside the portion55, may be used to hold the side branch, In this case, the holder 21 canhold the blood vessel at its concave surface 49. Thus, the blood vessel61 can be moved away from the bipolar cutter 18 by using the bloodvessel holder 21, in order to prevent the cutter 18 from contacting theblood vessel 61.

[0123]FIGS. 25A to 25C show a manual operation of cutting the sidebranch 72 by the bipolar cutter 18. Since the V groove 41 is formed inthe tip end of the bipolar cutter 18, and when the bipolar cutter 18 ismoved towards the side branch 72, the side branch 72 is drawn toward thebottom of the V groove 41. Therefore, as shown in FIG. 26A, the sidebranch 72 contacts the cut electrode 43, and the body-side electrode 42contacts the connective tissue on the blood vessel 71 or side branch 72.That is, in the bipolar cutter 18 according to the present embodiment,the side branch 72 can be guided into the electrodes 42, 43substantially positioned in the intersection of the respective sides 41a, 41 b by the wall surfaces of the V groove 41 corresponding to therespective sides 41 a, 41 b which form the V shape.

[0124] After confirming by the monitor image that the side branch 72contacts the cut electrode 43 and the body-side electrode 42 contactsthe connective tissue on the blood vessel 71 or side branch 72, theoperator operates a foot switch 80 of the high-frequency generationapparatus 56 to supply a high-frequency current. The body-side electrode42 contacts the blood vessel connecting tissue or the side branch 72 ata larger area than the cut electrode 43 contacts the tissue or the sidebranch 72. This means that the current density is higher in the cutelectrode 43 than in the body-side electrode 42. Hence, the cutelectrode 43 can cut the tissue efficiently. Then a region in contactwith the body-side electrode 42 of the connective tissue on the bloodvessel 71 or side branch 72 is coagulated, and the side branch 72 is cutby the cut electrode 43. That is, as FIG. 26B shows, the portion of theblood vessel 61 connected to the connective tissue on the blood vessel71 by the side branch 72 is cut off by cutting the side branch 72. Atthis time, since the body-side electrode 42 having the large contactarea is disposed on the upper side (body side) farther from the bloodvessel 61 than the cut electrode 43, the thermal influence on the bloodvessel 61 is minimized.

[0125] Since the bipolar cutter 18 is just pressed onto the blood vesselin this manner, the blood vessel can be cut. That is, operation otherthan the forward/backward movement is not required in cutting the bloodvessel. Therefore, operability is enhanced.

[0126] When the side branch 72 is cut as described above, as shown inFIG. 27, the blood vessel holder 21 is passed under the blood vessel 61to lift up the blood vessel. It is confirmed by the monitor image shownin FIG. 28 whether or not the side branch 72 is completely cut/treated.

[0127] The treatment sheath 2 is further pushed forwards in the cavity69. While observing the monitored image of the cavity 69, the surgeonmay move the blood vessel holder 21 toward the next side branch 72. Thesurgeon repeats the above-mentioned manual operation, using the bipolarcutter 18, on all side branches 72. The blood vessel 61 is thereby cutcompletely from the connective tissue on the blood vessel 71.

[0128] When the method of cutting the side branch 72 is repeated in thismanner, the foreign materials 81 such as blood, mucosa, and subcutaneousfat 73 adhere to the objective lens surface 4 a of the rigid endoscope4, and the view field by the rigid endoscope 4 is sometimes obstructed.In this case, while the operation portion cover 11 remains to begrasped, and when the wiper operation portion 28 is manually rotatedagainst an urging force of the torsion coil spring 29, as shown in FIG.29, the wiper 24 rotates via the wiper rod 25, and the foreign materials81 such as the blood, mucosa, and subcutaneous fat 73 sticking to theobjective lens surface 4 a can be scraped away by the scraping portion26 a of the wiper rubber 26.

[0129] The wiper 24 is urged by the torsion coil spring 29. When thewiper operation portion 28 is released from the fingers, the wiper isreturned in a retreat direction from the objective lens surface 4 a.Therefore, when the above-described operation is repeated several times,even the foreign materials 81 such as the subcutaneous fat 73 adheringto and not easily dropping from the objective lens surface 4 a cancleanly be scraped off. Moreover, when the fingers are released from thewiper operation portion 28, the wiper 24 returns, moving a away from theobjective lens surface 4 a and is still biased. Hence, the wiper 24would not project, by accident, into the view field. In other words,wiper 24 would not narrow the view field of the rigid endoscope 4.

[0130] Moreover, when the cutting of the side branch 72 by the bipolarcutter 18 is repeated, as shown in FIG. 30, the foreign materials 81such as the mucosa and subcutaneous fat 73 also adhere to the innersurface of the bipolar cutter 18 because of the roof shape of thebipolar cutter 18. However, when the bipolar cutter 18 is movedbackwards by the cutter operation portion 19 and drawn into the firsttreatment device channel 14, the mucosa and subcutaneous fat 73 arescraped off by the front end surface of the sheath main unit 10.Therefore, the foreign materials 81 adhering to the bipolar cutter 18can easily be scraped off. It is to be noted that in the presentembodiment, in order to scrape off the mucosa and subcutaneous fat 73adhering to the bipolar cutter 18 by the front end surface of the sheathmain unit 10, a clearance between the bipolar cutter 18 and sheath mainunit 10 (clearance between the outer surface of the bipolar cutter 18and the inner surface of the first treatment device channel 14) is setto be small.

[0131] As shown in FIG. 31, the scraped foreign materials 81 stick tothe objective lens surface 4 a of the rigid endoscope 4 and sometimesobstruct the view field. Even in this case, when the wiper operationportion 28 is operated to rotate the wiper 24 as described above, theforeign materials 81 sticking to the objective lens surface 4 a can bescraped off.

[0132] While the operation of scraping off the foreign materials 81sticking to the bipolar cutter 18 or objective lens surface 4 a isrepeated, the manual operation of cutting the side branch 72 to cut theblood vessel 61 from the connective tissue on the blood vessel 71 isrepeated. When the operation reaches the inguinal portion 63, thecutting of the side branch 72 is terminated. Subsequently, the smallincision is formed in the inguinal portion 63 right above the bloodvessel 61 with the scalpel. The blood vessel 61 is pulled out throughthe cut skin portion. The operator can cut the drawn portion of theblood vessel 61, and ligate both cut ends of the blood vessel 61 with asuture.

[0133] Subsequently, the harvesting operation of the blood vessel 61extending toward the ankle from the cut skin portion 64 of the knee 62is carried out and finally one blood vessel (about 60 cm) is harvestedfrom the cut skin portion 64. The manual operation is basically similarto the manual operation performed on the blood vessel 61 extending tothe inguinal portion 63 from the knee 62, and the description thereof isomitted. The vessel which is cut on its both sides is removed from thecut skin portion 64.

[0134] In the method of harvesting the blood vessel 61, a manualoperation is performed on the inguinal portion 63, and another manualoperation is performed at the ancle. Instead, the blood vessel 61 may befirst scraped from the connecting tissue 71 at both the inguinal portion63 and the ancle. Then, the treatment sheath 2 may be used in place ofthe dissector 3 when the blood vessel 61 is completely cut from theconnecting tissue 71. This reduces the number of times the sheath 2 andthe dissector 3 should be exchanged with each other. The manualoperation can be more smoothly carried out than otherwise.

[0135] As described above, in the bipolar cutter 18 as the treatmentdevice for cutting the living tissue of the present embodiment, the Vgroove (guide portion) 41 along which the blood vessel is guided intothe electrodes 42, 43 with movement of the cutter main unit 40 in anaxial direction is formed in the tip-end treatment portion 40 a.Therefore, when the cutter main unit 40 is simply movedforwards/backwards, the blood vessel can be approached andsimultaneously cut. That is, when the tip-end treatment portion 40 a(electrodes 42, 43) is pressed onto the object blood vessel to be cutand electricity is supplied, the blood vessel can be cut. Therefore,without performing further operation of pressing and moving the blade oropening/closing the jaw as in the related art, the blood vessel can becut (the blood vessel can easily be cut).

[0136] Moreover, a pair of electrodes 42, 43 of the bipolar cutter 18 ofthe present embodiment are different from each other in a contact areain contact with the living tissue, and the living tissue is incised bythe electrode 43 which has a small contact area. That is, the contactarea of the body-side electrode 42 is larger than that of the cutelectrode 43, thereby the electric current concentrates in the cutelectrode 43. Thus, the current density is high in the cut electrode 43.The blood vessel can be easily cut (incised), merely by pressing theelectrodes 42 and 43 onto the blood vessel (i.e., side branch 72) andpassing a current.

[0137] Furthermore, in the bipolar cutter 18 of the present embodiment,the body-side electrode 42 having a large contact area is disposed on anupper side (body side) farther from the blood vessel 61 than the cutelectrode 43 is. That is, a distance between the body-side electrode 42having a large contact area and the blood vessel holder 21 is set to belonger than that between the cut electrode 43 having a small contactarea and the blood vessel holder 21. When the electrode 42 having thelarge contact area is disposed to be as distant from the harvested bloodvessel 61 as possible, thermal influence on the blood vessel 61 can beminimized. Additionally, after the cutting, the side branch 72 remainingin the body can also be stopped from bleeding.

[0138]FIGS. 32A and 32B show a first modification example of theabove-described bipolar cutter. For the V groove 41 of a bipolar cutter18A according to this modification example, a portion on an electrodes42, 43 side is largely narrowed down. That is, the portion of the Vgroove 41 on the electrodes 42, 43 side is formed as a restricted groove100 which has a width smaller than that of the portion on a tip-endopening side of the V groove 41.

[0139] In this constitution, as shown in FIGS. 33 and 34, when the sidebranch 72 is buried in the subcutaneous fat 73, the bipolar cutter 18Ais pressed onto the subcutaneous fat 73 to introduce the side branch 72and the subcutaneous fat 73 around the side branch into the V groove 41.When the bipolar cutter 18A is further pushed forwards from this stateof FIG. 35, as shown in FIG. 36, only the side branch 72 can beintroduced into the restricted groove 100 having the small width. Thatis, by this restricted groove 100, the subcutaneous fat 73 is removedfrom the periphery of the side branch 72, and only the side branch 72can be brought into contact with the electrodes 42, 43 and cut (see FIG.37).

[0140]FIG. 38 shows another use mode of the restricted groove 100. Thatis, in the state of FIG. 36, the hook portion 55 of the blood vesselholder 21 is caught in the middle of the side branch 72 to pull theblood vessel holder 21 toward the hand side and tension is applied tothe side branch 72. While this state is kept, as shown by arrows in FIG.38, the bipolar cutter 18A is slightly moved forwards/backwards and slidupwards, and the subcutaneous fat 73 can be stripped from the peripheryof the side branch 72 by the restricted groove 100.

[0141] FIGS. 39 to 42 show another use mode of the restricted groove100. In this use mode, the groove width of the restricted groove 100 isset to be smaller than the diameter of the side branch 72. Therefore, asshown in FIGS. 39 to 41, when the side branch 72 is inserted into therestricted groove 100, the side branch 72 is compressed in therestricted groove 100, and finally opposite blood vessel walls of theside branch 72 contact each other (see FIG. 41). Even when electricityis supplied to the electrodes 41, 42, the blood flow in the compressedportion of the side branch remains to be cut off, but the side branch 72is coagulated/incised, and the cut surface is stopped from bleeding (seeFIG. 42). Thus, both cut ends are sealed.

[0142] When the groove width of the restricted groove 100 formed in theV groove 41 is set to be smaller than the diameter of the blood vesselas the cutting object in this manner, the blood vessel can be compressedto stop the blood flow, and coagulated/incised. Therefore, it ispossible to perform very useful incision/bleeding stop.

[0143] It is to be noted that in this case even with the restrictedgroove 100 as a parallel groove having a uniform groove width over thetotal length, or the groove having a gradually tapered grooveconfiguration, the equivalent effect is obtained. Moreover, in themanual operation of extracting a saphenous vein, a width L of therestricted groove 100 (see FIG. 39) is preferably 0.3 mm to 0.7 mm.

[0144]FIG. 43 shows a second modification example of the above-describedbipolar cutter. A V groove 41A of a bipolar cutter 18B according to thismodification example is formed in a lateral portion of the tip-endtreatment portion 40 a. In this constitution, the side branch 72 canlaterally be approached and cut. In this case, the side branch 72 isintroduced into the V groove 41A beside the tip-end treatment portion 40a. When the sheath main unit 10 is rotated in this state as shown byarrows in FIG. 43, the side branch 72 can easily be cut by theelectrodes 42, 43. That is, the V groove 41 of the above-describedembodiment guides the blood vessel 61 into the electrodes 42, 43 withthe movement of the cutter main unit 40 in the axial direction, but theV groove 41A of the present modification example guides the blood vessel61 into the electrodes 42, 43 with the movement of the cutter main unit40 in a direction substantially crossing at right angles to the axialdirection.

[0145]FIGS. 44 and 45 show a second embodiment of the treatment devicefor cutting the living tissue according to the present invention. In theabove-described embodiment, the treatment device for cutting the livingtissue is incorporated in the endoscopic blood vessel harvestingapparatus, but the treatment device for cutting the living tissue of thepresent embodiment can be inserted into the body alone and can cut theblood vessel alone.

[0146] That is, as shown in FIGS. 44 and 45, a bipolar cutter 118 as thetreatment device for cutting the living tissue of the present embodimentincludes: a cutter main unit 140 to be inserted into the body; a tip-endtreatment portion 140 a, disposed in the tip end of the cutter main unit140, for cutting the blood vessel; and electrodes 142, 143, disposed inthe tip-end treatment portion 140 a, for electrically cutting the bloodvessel. The cutter main unit 140 is formed of an insulating member(including ceramic) such as a synthetic resin material, andsubstantially has a flat plate shape. Moreover, the electrodes 142, 143are electrically insulated from each other by an insulator disposedbetween the electrodes.

[0147] Moreover, a guide portion for guiding the blood vessel into theelectrodes 142, 143 with the movement of the cutter main unit 140 in theaxial direction is formed in the tip-end treatment portion 140 a of thecutter main unit 140. In the present embodiment, this guide portion isformed by a notch groove (slit) 141 cut in a V shape. In this case,sides 141 a, 141 b forming the V shape extend upwards toward a circulararc shaped top portion in the proximal end from opposite side edges ofthe cutter main unit 140 in the distal end to form a tissue guidesurface of the notch groove (hereinafter referred to as the V groove)141 which tapers toward the proximal end.

[0148] Furthermore, a pair of electrodes 142, 143 disposed opposite toeach other are fixed/disposed on a bottom of the V groove 141, that is,an intersection of the respective sides 141 a, 141 b forming the Vshape. These two electrodes 142, 143 are not disposed in the same plane,and are positioned vertically opposite to each other.

[0149] Additionally, for these two electrodes, the upper electrode 142has a surface area larger than that of the lower electrode 143. That is,the area of the upper electrode 142 in contact with the tissue is large.On the other hand, the area of the lower electrode 143 in contact withthe tissue is small. As the first embodiment, the lower electrode 143 isallowed to function as an incision (cutting) electrode, and the upperelectrode 142 is allowed to function as a coagulation electrode.

[0150] Moreover, a handle 102 is disposed in the proximal end of thecutter main unit 140. An electric cable 105 connected to thehigh-frequency generation apparatus 56 extends from the handle 102.Furthermore, switches 103 for controlling the electric supply to theelectrodes 142, 143 are disposed on the handle 102.

[0151] FIGS. 46 to 48 show one example of the use mode of the bipolarcutter 118. FIGS. 46 and 47 show a mode in which the bipolar cutter 118is used to harvest the blood vessel (great saphenous vein) 61 extendingto the ankle from the inguinal portion 63 of the femoral region of theleg 60. The harvesting method using the bipolar cutter 118 comprises:entirely incising the leg 60 along the blood vessel 61 to be harvested;and completely exposing the whole blood vessel 61 to be harvested. Inthis state, the side branch 72 is introduced into the V groove 141 asshown in FIG. 47 so as to cut the blood vessel. Also in this case,similarly to the above-described embodiment, since the V groove 141 isdisposed, the bipolar cutter 118 can simply be pushed forwards to easilycut the side branch 72. Moreover, FIG. 48 shows a mode in which thebipolar cutter 118 is used in the manual operation of stripping anadhering portion 163 of an organ 160 and body wall 161. As shown, whenan adhering tissue is introduced into the V groove 141 and the cutter ispushed forwards along the adhering portion 163, the adhering portion 163of the organ 160 with the body wall 161 can easily be stripped.

[0152] As described above, also in the bipolar cutter 118 of the presentembodiment, the V groove (guide portion) 141 which guides the bloodvessel into the electrodes 142, 143 with the movement of the cutter mainunit 140 in the axial direction is formed in the tip-end treatmentportion 140 a. Therefore, the cutter main unit 140 is simply movedforwards/backwards, so that the blood vessel can be approached and alsocut.

[0153]FIGS. 49A to 50B show modification examples of formedconfigurations of the electrodes 42, 43 (142, 143) in theabove-described both bipolar cutters 18, 118.

[0154] In FIGS. 49A and 49B, the body-side electrode 42 (142) isdisposed over the total length of each side of the V groove 41 (141).Concretely, as shown in FIG. 49B, the body-side electrode 42 (142) isdisposed in the upper edge of the wall surface of the V groove 41 (141)corresponding to each side forming the V shape. Moreover, the cutelectrode 43 (143) is disposed in the intersection of the respectivesides forming the V shape in the same manner as in the above-describedembodiment. As clearly shown in FIG. 49B, the body-side electrode 42(142) and cut electrode 43 (143) are not disposed in the same plane, andare positioned vertically opposite to each other.

[0155] When the body-side electrode 42 (142) is disposed over the totallength of each side of the V groove 41 (141) in this manner, the surfacearea of the body-side electrode 42 (142) can further be set to be largerthan that of the above-described embodiment. As a result, the ratio ofthe contact area of the body-side electrode 42 (142) to that of the cutelectrode 43 (143) can be enlarged. Therefore, the incision function canfurther be imparted to the cut electrode 43 (143) side, and a cuttingforce is improved (cutting function is enhanced).

[0156] Moreover, in FIGS. 50A and 50B, the body-side electrode 42 (142)is disposed over the total length of each side of the V groove 41 (141)in the same manner as in FIGS. 49A and 49B, and the cut electrode 43(143) is disposed opposite to the body-side electrode 42 (142) in oneside of the V groove 41 (141). In this case, the cut electrode 43 (143)has a sharply tapered portion 169 in the tip end, and extendssubstantially over the half of the side of the V groove 41 (141).

[0157] According to this constitution, a function/effect similar to thatof FIGS. 49A and 49B is obtained, and the cut electrode 43 (143)obliquely bites and cuts the tissue (blood vessel) via the taperedportion 169. Therefore, the constitution is superior in an incisionforce, and produces an effect, particularly when the side branch 72 isburied in the subcutaneous fat 73.

[0158] FIGS. 51 to 52B show a modification example of the bipolar cutter118 shown in FIG. 44. As shown, a bipolar cutter 118A according to thismodification example includes a blood vessel abutment portion 170 fordrawing the blood vessel into the V groove 141. This blood vesselabutment portion 170 includes: a longitudinal shaft portion 170 b; and ahold bar 170 a which is bent substantially at right angles in the tipend of the shaft portion 170 b and disposed opposite to the V groove141. The shaft portion 170 b extends over the total length of the cuttermain unit 140 (passes, for example, through the cutter main unit 140),and is connected to an operation portion 171 disposed in the handle 102.The operation portion 171 can slide forwards/backwards in an elongatedgroove 172 formed in the handle 102. Therefore, when the operationportion 171 is slid forwards/backwards in this constitution, the shaftportion 170 b is pushed/pulled, and the hold bar 170 a can move withrespect to the V groove 141. Moreover, urging means 174 such as a springis disposed between the operation portion 171 and cutter main unit 140.This urging means 174 urges the operation portion 171 in a direction inwhich the hold bar 170 a is detached from the V groove 141. It is to benoted that another constitution is the same as that of the bipolarcutter 118 shown in FIG. 40 and is denoted with the same referencenumerals and description thereof is omitted.

[0159] Therefore, in this constitution, the blood vessel is positionedbetween the hold bar 170 a and V groove 141, the operation portion 171is slid toward the hand side against the urging force of the urgingmeans 174 in this state, then the hold bar 170 a is moved on a V groove141 side, and the blood vessel is drawn into the V groove 141 by thehold bar 170 a. Moreover, when the hold bar 170 a is drawn into aposition shown, for example, by a broken line in FIG. 52A, the bloodvessel can be pressed into contact with the electrodes 142, 143.

[0160] As described above, according to the present modificationexample, the blood vessel is further easily cut by a synergistic effectof guide functions by the V groove 141 and hold bar 170 a. In addition,high-efficiency hemostasis can be achieved since the blood vessel is cutwhile being compressed.

[0161] FIGS. 53 to 54B show a third embodiment of the treatment devicefor cutting the living tissue according to the present invention. Thetreatment device for cutting the living tissue in the above-describedembodiment is of a bipolar type, but a treatment device for cutting theliving tissue 218 of the present embodiment is of a monopolar type.

[0162] That is, as shown in FIG. 53, the treatment device for cuttingthe living tissue 218 includes: a cutter main unit 240 which is to beinserted into the body; a tip-end treatment portion 240 a which isdisposed in the tip end of the cutter main unit 240 so as to cut theblood vessel; and an electrode (monopolar) 242 which is disposed in thetip-end treatment portion 240 a and which electrically cuts the bloodvessel together with a counter electrode plate 302 disposed in thetip-end treatment portion 240 a in contact with a living tissue 300. Thecutter main unit 240 is formed of the insulating member (e.g., ceramic)of the synthetic resin material and substantially forms a flat plateshape.

[0163] Moreover, as clearly shown in FIGS. 54A and 54B, the guideportion for guiding the blood vessel into the electrode 242 with themovement of the cutter main unit 240 in the axial direction is formed inthe tip-end treatment portion 240 a of the cutter main unit 240. In thepresent embodiment, this guide portion is formed by a notch groove(slit) 241 cut in the V shape. Furthermore, the electrode 242 isfixed/disposed in the bottom of the V groove 241, that is, theintersection of the respective sides which form the V shape.

[0164] Furthermore, a handle 202 is disposed in the proximal end of thecutter main unit 240. An electric cable 205 connected to thehigh-frequency generation apparatus 56 extends from this handle 202.Additionally, a foot switch 80 for controlling the electricity supply tothe electrode 242 is connected to the high-frequency generationapparatus 56.

[0165] Even with the monopolar constitution, when the V groove 241 isformed in the tip-end treatment portion 240 a, the function/effectsimilar to that of the above-described bipolar constitution can beobtained.

[0166] It is to be noted that needless to say the present invention isnot limited to the above-described embodiments and can variously bemodified/implemented without departing from the scope. For example,although the present invention is applied to the blood vessel harvestingapparatus in the above-described embodiments, the present invention canalso be applied to the harvesting of living tissues other than the bloodvessel.

What is claimed is:
 1. A treatment device for cutting a living tissue,comprising: a main unit which is to be inserted in a body; a tip-endtreatment portion which is disposed in a tip end of the main unit to cutthe living tissue; a notch groove which is disposed in the tip-endtreatment portion and into which the living tissue is introduced tothereby compress this living tissue; and an electrode which ispositioned in a part of the notch groove and which electrically cuts theliving tissue compressed by the notch groove.
 2. The treatment devicefor cutting the living tissue according to claim 1, wherein the notchgroove forms a guide portion which guides the living tissue into theelectrode with movement of the main unit.
 3. The treatment device forcutting the living tissue according to claim 1, wherein the guideportion guides the living tissue into the electrode with movement of themain unit in an axial direction or a direction crossing at right anglesto the axial direction.
 4. The treatment device for cutting the livingtissue according to claim 1, wherein the guide portion has a V shape,and guides the living tissue into the electrode by a wall surface of thenotch groove corresponding to each side which forms the V shape.
 5. Thetreatment device for cutting the living tissue according to claim 4,wherein the electrode is disposed in each side of the V shape.
 6. Thetreatment device for cutting the living tissue according to claim 1,wherein the electrode is a monopolar or bipolar high-frequencyelectrode.
 7. The treatment device for cutting the living tissueaccording to claim 1, wherein the electrode includes a pair ofhigh-frequency electrode portions different from each other in a contactarea in contact with the living tissue, and the living tissue is incisedby the electrode portion (43) which has a smaller contact area.
 8. Thetreatment device for cutting the living tissue according to claim 7,wherein the pair of electrode portions are not disposed in the sameplane.
 9. The treatment device for cutting the living tissue accordingto claim 1, wherein portions other than the electrode are formed oftransparent materials.
 10. A blood vessel harvesting apparatuscomprising: a sheath which can be inserted into a cavity through a cutskin portion; and a blood vessel harvesting portion which movesforwards/backwards in the sheath to harvest a blood vessel in thecavity, wherein the blood vessel harvesting portion comprises: a bipolarincision device which incises a living tissue; and a holder which holdsa harvesting object blood vessel, the bipolar cutting device comprises:a main unit which is inserted into a body through the sheath; a tip-endtreatment portion which is disposed at a tip end of the main unit to cutthe living tissue; and a pair of electrodes disposed at the tip-endtreatment portion, the pair of electrodes are different from each otherin a contact area in contact with the living tissue, and a distancebetween the electrode having a large contact area and the holder islonger than that between the electrode having a small contact area andthe holder.
 11. A blood vessel harvesting apparatus comprising: a sheathwhich can be inserted into a cavity through a cut skin portion; and ablood vessel harvesting portion which moves forwards/backwards in thesheath to harvest a blood vessel in the cavity, wherein the blood vesselharvesting portion comprises a bipolar cutting device which cuts aliving tissue, and a holder which holds a harvesting object bloodvessel; the bipolar cutting device comprises: a main unit which isinserted into a body through the sheath; a tip-end treatment portionwhich is disposed in a tip end of the main unit to cut the livingtissue; and a pair of electrodes disposed in the tip-end treatmentportion, and the tip-end treatment portion comprises a guide portionwhich guides living tissues to the electrodes as the tip-end treatmentportion is moved.